February 11, 2013 - Nursing Home Help

APRNS PHASING INTO “GO LIVE” IN THE FIRST SEVEN FACILITIES!Orientation is progressing as each APRN and nursing home leadership team tailor their APRN’sorientation. Everyone is gaining more understanding of the nursing home’s unique systems of caredelivery and communication with residents, families, and staff.As each home “goes live” (see dates below) their APRN will become even more acquainted with eachresident in the Initiative. Recall the “go live” date is the date when APRNs can begin “officiallytouching” residents. This date is two weeks after your facility (a) gave the notification letter to eachresident; (b) mailed a notification letter to each resident’s family member and/or “designee.” Thistwo week window allows them time to “opt out” of the Initiative.And, recall after this “go live” date, residents will be continuously enrolled, so there is no need for the2 week window. All new admissions that are going to be long-stay residents on admission should get acopy of the MOQI Overview Q&A and resident letter about the MOQI Initiative (those were attachedwith the last Update).A process that we have suggested: 1) include the MOQI Overview Q&A document with all admissionpackets, so that the resident and their designee are informed about the Initiative on admission. 2) Atthe time when the decision is made for the resident to remain in your home as a long-stay resident,the social worker/designee would provide the resident and their family/designee with a copy of theappropriate letters. 3) Communication about the Initiative should continue to be a topic ofconversation ongoing at resident council meetings, family nights, via facility newsletters and atscheduled care planning meetings, as indicated.We have learned that several of you have developed really nice processes/format for continuing anddocumenting that notification process ongoing. If you would like to share, please bring samples ortheir format to share with others. It won’t be long before the next group needs to use the sameformat/procedures and it would be great not to recreate processes!So, after the “go live” date, APRNs will begin systematically completing “comprehensive assessments”of residents. The purpose of comprehensive assessments is to prepare each ARPN to be able to:1) Be aware of what is “normal” for this resident, so early detection of changes in healthconditions can be done by the APRN; and the APRN can help the staff, residents, and familiesknow what to watch for, too!2) Be familiar with each resident as a “person.” This entails becoming knowledgeable aboutresidents’ health challenges, their current physical condition, goals for improvement ormaintenance of functional status, and identifying their life goals, as well as their desires fortheir end of life care.The comprehensive assessment for each resident will include a review of the clinical record for themost recent assessments, including most recent history and physical, current physician’s orders

including medication orders, progress notes, MDS assessment, care plan, recent and past history ofhospitalizations, and other pertinent clinical information.This approach to resident assessment is not meant to be a complete physical exam for each resident.It is to be a review of the clinical record, discussion with each resident, assessment of clinical needsand potential issues that could become changes in the residents’ health status. The APRNs aredeveloping a streamlined form for this assessment for their use and sharing with other staff in theclinical record. Location of the documentation may vary by facility, depending on the chartorganization. A likely location is in an area of the chart that has other clinical assessments by otherhealth care providers. Leaders and APRNs will agree on a location so staff can consistently locate thisinformation and other progress note information that the APRN will be noting on the resident chartas conditions change and documentation is necessary.The APRN will also be learning about each organization’s system of care delivery by observing staffas they engage in care processes. These observations will help the APRN understand how eachorganization functions as well as to assist in building relationship with staff, residents, and families.The purpose for the comprehensive assessment is for each APRN to begin learning about eachresident as well as each organization’s care delivery system so they can work with facility staff andintervene to accomplish the project goals:1) Reduce the frequency of avoidable hospital admissions and readmissions by at least 35%;2) Improve nursing home residents' health outcomes;3) Improve the process of transitioning between inpatient hospitals and nursing facilities; and4) Reduce overall health care spending without restricting access to care or choice of providers.Recall the exact date that your APRN can begin to assess residents will vary by home, based onthe two-week window of notifying residents and families. These dates are:Facility Name Distribute Notification/Opt-Out Forms “Go-Live” DateAlexian Brothers Lansdowne Village 1/18/2013 2/1/2013Cedarcrest Manor 1/21/2013 2/4/2013Delmar Gardens of Chesterfield 2/1/2013 2/15/2013Delmar Gardens of O'Fallon 2/1/2013 2/15/2013Delmar Gardens West 2/1/2013 2/15/2013Delmar Gardens of Creve Coeur 2/2/2013 2/16/2013NHC Healthcare, Town and Country 2/4/2013 2/18/2013INTERACT/QIPMO COACH HIRED!Dr. Dotty Blank has been hired as the INTERACT/QIPMO Coach (IQC) and will begin this week.As a DON in LTC for the past 5 years, she was responsible for facilitating the education andtraining of all staff, including the INTERACT program. Her proficiency in staff training anddevelopment will be a great asset to the initiative. As she gets oriented to her role, she will helpeach facility develop a plan for educating and implementing the INTERACT program and tools.Thanks for all your efforts to get Stop and Watch tools introduced in the facilities. Now we will helpexpand the program and tools in each facility with Dotty’s help.

MORE APRNS INTERVIEWED LAST WEEK!!Annette Lueckenotte and Marcia Flesner conducted interviews the beginning of the first week ofFebruary and have really good candidates for almost all of the nursing facilities in the second wave.They will begin interviewing in the facilities soon so selections can be finalized with facilityleadership. We are pleased with the experiences and qualifications that the new APRNs will bring tothe Initiative.HEALTH INFORMATION EXCHANGE NETWORK - PROGRESS!We are continuing to plan for implementation of the health information exchange network. We haveidentified all the system coordinators who will be helping our team to manage the health informationnetwork in each facility. We would like to recognize the coordinators who have been identified in thefirst 7 facilities:Alexian Brothers Lansdowne Village - Nance TheirCedarcrest Manor - Dana BaileyDelmar Gardens Chesterfield - Linda PetersDelmar Gardens Creve Coeur - Kevin GradyDelmar Gardens O'Fallon - Trish LunaDelmar Gardens West - Shelly GrooseNHC, Town & Country - Jennifer WednerWe would like to extend our gratitude to these individuals who will be supporting this part of theintervention in each home. Ila Irwin, from Missouri Health Connection, will be contacting eachfacilities administrator and coordinator to confirm dates for the initial training and implementationprocesses. Prior to the training dates, the MOQI Team (with the HIT Lead and HIT Coach) will meetwith Delmar Gardens corporate staff to discuss security aspects of the health information exchangeso that processes are ready for implementation in the facilities.Additionally, we are getting close to a final decision about the technology to be used with thiscommunication network. Our tablets of choice are Microsoft Surface tablets. We are currentlyevaluating the technology to ensure that we are purchasing technology that meets our needs fromboth a user and a technical perspective. We should have a final decision about this by the secondweek of February and will order our first batch of computers for the project. Thanks to everyonewho participated in the pilot testing of the computers! Your input is invaluable to making the rightdecision for a product that will work well for all of us.FACILITY RESIDENT ROSTER PROCEDURESSue and Susie (Health IT Coach and Care Transitions Coach) are working with staff in each facility toget their resident rosters completed to reflect the accurate list of all residents in each facility on their“go live” date. Many thanks to MDI Achieve staff who helped us tremendously by providing data fromthe electronic billing and MDS care plan systems for many of the facilities in the Initiative. This helpsavoid errors in all the numbers that must be recorded for each facility and it saves staff time so thatcorrections can be made, rather than data input for every single resident. Many thanks to Dr.

Galambos, Care Transitions Lead, for validating eligibility for each resident; this has been no smalltask!Recall that after the initial mail-out of letters, it will be necessary to have a system for on-goingnotification of residents and families. All new admissions that may become or are going to belong-stay residents must get a copy of these letters on admission. However, the two weekwindow for enrollment will NOT be needed after the initial blanket enrollment. Ongoing,hopefully, social service or admissions staff will be able to obtain their consent at the time theinformation is provided upon admission or when they become eligible as a long-stay resident toparticipate in the Initiative.UPCOMING MEETINGS!!Our Next MOQI NF Leadership Group Meeting Tuesday, February 12, 2013, at Delmar Gardensmeeting room from 10-11:30am! Mark your calendars and plan to attend! Delmar Gardens HomeOffice, 14805 North Outer 40 Road, 3 rd floor, Chesterfield, MO 63017.Beginning in March, the NF Leadership Group Meetings will be changing to the first Tuesday of eachmonth:March 5, 2013 April 2, 2013 May 7, 2013 June 4, 2013August 6, 2013 October 1, 2013 December 3, 2013All meetings will still be held at Delmar Gardens Home Office in Chesterfield, at the same time of 10-11:30am.Our Next MOQI STAKEHOLDER ADVISORY BOARD meeting will be Thursday, April 18, 2013, atDelmar Gardens meeting room from 1-3:30pm. Mark your calendars and plan to attend! DelmarGardens Home Office, 14805 North Outer 40 Road, 3 rd floor, Chesterfield, MO 63017.TOPICS FOR UPCOMING MOQI UPDATESIf you have a particular request, please submit to Jessica Mueller and we will be sure to cover it. Comingup in future issues: Introductions to more members of the MOQI Team hired so far so you can get to knowthem. Some were at the MOQI Leadership Group Meeting. We want to formally introduce them to you!CONTACT INFORMATIONIf you would like others to be added to this communication list, please contact Jessica atmuellerjes@missouri.edu or (573) 882-0241.WEBSITE SECTION FOR YOUR USEThere is a special section on the www.nursinghomehelp.org site for us to use for the Initiative. Itcontains contact information, material/overviews, copies of all of the updates, etc. Use the link belowor type it in and bookmark it: http://nursinghomehelp.org/moqi.html. If there is something youwould like to request be added, please e-mail Jessica.Participating nursing home administrators, please share these weekly MOQI Updates with your directorof nursing and other leadership staff so they start getting informed about the MOQI Initiative.